Procedures and operations for men as part of a fertility treatment

Whether or not a man is fertile depends largely on his sperm production. This is controlled and regulated hormonally, but not all problems can be blamed on hormonal imbalance. Sometimes psychological factors are the reason, or else an obstruction somewhere along the sperm's journey both in the man's and woman's body. See also the sperm quality for the requirements a sperm sample needs to meet for 'normal' fertility.

Treatment for impotence

Research into male factor infertility has taught us that in a large group of men, one particular abnormality cannot be established apart from an abnormal sperm analysis. Clear causes for which there is a specific treatment are only found in a small number of cases.

The CRG doctor will try to find out via andrological tests whether there is a specific issue which is contributing or causing the fertility problems which you and your partner are experiencing. See looking for the cause , under examinations for men.If this is the case, a 'specific treatment' can solve your particular problem. For one example of this, see hormone treatments.

Quite often, however, no specific cause can be found, or no specific treatment is available. In 95% of cases, a 'non-specific' type of treatment must be found, in other words, something not directly aimed at solving one particular problem. ART treatment is the best example of course: artificial insemination and IVF of IVF | ICSI do not cure reduced fertility, but simply bypass the problem. The end result, if the procedure works, is pregnancy. For ICSI, you may have to undergo a procedure for the extraction of sperm. These procedures are discussed under TESE and other procedures for sperm extraction.

If your fertility problem was caused by potency disturbances (impotence, anejaculation, retrograde or premature ejaculation), we used to subject you to an array of tests aimed at identifying the exact cause. Nowadays there is a more empirical approach to treatment.

Ejaculation problems

AnejaculationIf you can have an erection but are unable to reach ejaculation, psychological therapy may help. If this is not the case, ejaculation can be triggered by stimulation. This involves a procedure, see vibro and electrostimulation. The sperm sample produced can possibly be used in the fertility treatment of you and your partner.

Retrograde ejaculationThis refers to the condition whereby the ejaculate goes into the bladder instead of out through the penis. In other words, no seminal fluid is released when you ejaculate.If we suspect this is the problem, your urine will be examined for the presence of sperm. If so, your urine must first be alkalinised, or made less acidic and toxic for the sperm, if they are, potentially, to be used for your fertility treatment.

Erectile dysfunctions

In case of erectile dysfunctions the doctor will ask you a number of questions and examine you. Do you have high blood pressure? Do you have high cholesterol? Do you have diabetes?

Viagra If the answer to these questions is no, sildeafilcitrate, known worldwide as viagra, may be suggested. This medication prevents the break-up of the molecule which causes the penis to swell with blood during an erection. This will enable you to obtain and maintain an erection more easily (again).

Prostaglandins If viagra doesn't help, an alternative is the injection of prostaglandins into the penis. These hormones are normally produced in the prostate and one of their functions is to ensure you can get an erection and have an orgasm.

Penis prosthetic A last resort is the implantation of an inflatable penis prosthetic. After this procedure you will be able to obtain an erection by squeezing the scrotum.

Hormone treatment is often carried out with the co-operation of the Endocrinology department - the hormone specialists - at UZ Brussel. In theory of fertility, we learned which hormones form the basis of our fertility and how they organise sperm production in men:

in the brain this is GnRH and the gonadotrophins LH and FSH;

in the reproductive organs this is chiefly testosterone, the hormone produced by sperm. If sperm production is low, testosterone levels are low and the brains receive the message to step up production of FSH and LH.

Administration of gonadotrophins

In rare cases, such as when the man has Kallman syndrome - there is no production of GnRH in the hypothalamus. As a result, the hypophysis does not produce gonadotrophins and there is no sperm production. The testicles are small like those of a pre-pubescent boy. To stimulate the production of sperm, gonadotrophin substitutes are injected at a rate of twice a week, for a couple of months. It takes almost three months to produce sperm. This means you need to take the hormones for this amount of time for at least one good sperm sample.If successful, the sperm sample is collected and used for IVF with ICSI.The treatment also has a number of side effects and cannot be implemented on a permanent basis. For this reason it is generally continued just long enough to produce several good sperm samples which are then frozen and stored for later use.

Testosterone treatment

As we can conclude from the bodybuilder story (see the central heating principle), the administration of testosterone forms no useful role in fertility treatment. Quite the contrary in fact. This treatment, which can be either in the form of three-weekly injections or daily gel form, is carried out to avoid the unpleasant effects of testosterone deficiency, such as low libido and bone calcification.

A specific group of men who have a testosterone deficiency, are those with Klinefelter syndrome. If a sufferer wishes to father children he must have a TESE-operation to obtain sperm for ART treatment. You have to stop the testosterone therapy at least three months before you have a TESE operation.